The present invention relates generally to the field of surgery. More specifically, the present invention relates to a vacuum-type surgical instrument that may be utilized as a retractor, extractor, and manipulator of a target tissue.
The quality and efficient progress of a surgical case depends on adequate visualization of the internal organs. A surgeon will typically use retraction devices to move certain organs or hold them in place so that another structure, organ, or pathologic entity can be visualized adequately to facilitate surgery on the structure. The most common devices used for retraction involve metal retractors which have been produced in various shapes and sizes to provide atraumatic manipulation of delicate living tissues. Such sharp or rigid clamp devices, such as forceps, are often coupled to organs and traction applied to move the organ away from the surgical site to expose the surgical area in question. Occasionally the organs are retracted so that adhesions attached to those organs are stretched or placed under tension and can be more easily lysed, cut or dissected. For example, adhesions which connect the fallopian tubes, ovaries and uterus can be better visualized if the uterus is retracted exposing the adhesions so that surgical lysis with a sharp tool or laser dissection can progress more accurately and swiftly.
Complications may result from the use of conventional clamping devices of the prior art. Clamping devices frequently traumatize and damage the tissue or organs to which they are clamped. These complications may be compounded in laparoscopic surgery due to the limited visibility and space constraints commiserate with such surgery.
Laparoscopy involves small incisions (typically on the order of 5 to 12 mm, and up to 20 mm) in the abdomen or pelvis through which instruments or probes are placed for dissection, manipulation, extraction, and other operative techniques. Due in particular to this limited accessibility, there is a need for atraumatic retraction devices that can apply a high degree of leverage and forcefully retract, extract, or manipulate certain intra-cavity structures or organs to facilitate dissection or enhance visualization of adjacent structures.
Suction cups of various shapes and sizes have been used in the field of obstetrics to assist in the vaginal and operative delivery of newborns for over thirty years. Current state of the art involves the suction cup that is applied to the fetal scalp during the second stage (pushing through the birth canal) of labor. The obstetrician applies traction to the infant""s head via a xe2x80x9cstring,xe2x80x9d xe2x80x9cwandxe2x80x9d or xe2x80x9cflexible or rigid shaft with a handlexe2x80x9d coupled to the suction cup. The traction is applied in an outward fashion while the delivering mother pushes, thereby assisting in the delivery of the newborn. These suction cups are typically made of silicone, rubber, vinyl or other plastic, or combinations of plastic and rubber. Suction is generally applied through suction tubing which is coupled to a nipple on the vacuum cup, the nipple communicating with the interior of the cup. The method by which the suction is produced can vary from large stationary mechanical vacuum/suction devices to hand-held pumps similar to that which are used to bleed brake fluid from brake lines of automobiles.
It has been proposed to similarly utilize suction devices to manipulate tissue during surgery. Such proposals have generally fallen short of expectations, and have exhibited various disadvantages. For example, U.S. Patent to Bilweis discloses an endoscopic surgical instrument which includes a tube with a suction cup at one end and a bulb at its opposite end. The cup is placed on a target tissue and the bulb is compressed and released in order to apply a suction to the tissue. The tissue is released by again compressing the bulb. The Bilweis device, however is difficult to utilize in that the surgeon has very little control over the level of vacuum applied to the tissue, and no means by which to determine the level that is applied. Further, releasing the tissue may be difficult or impossible in that the vacuum may not be completely released upon complete compression of the bulb. Moreover, manipulation of the tissue is limited by the direct application of force along the tube, either by movement of the tube or by movement of a trocar through which the tube extends. These fields of movement are not versatile, and may be inadequate for purposes of a given surgery. Additionally, tensioning the Bilweis device requires the assistance of a second medical professional.
In overcoming these and other disadvantages of the prior art, the invention provides a surgical vacuum device including a vacuum cup sized for attachment to and manipulation of a target tissue. For the purposes of this disclosure, the term target tissue will be used to indicate any tissue to which the device will be applied, and specifically includes organs as well as any other bodily tissue, even if it is not specifically stated. The device further includes a vacuum hose for applying a vacuum to the interior of the cup, and structure for applying a tensioning force to the cup once it has been placed and a vacuum applied. The tensioning structure may be in the form of the vacuum hose itself, a control shaft, a handle, or tensioning cords or hooks coupled to the cup either directly or via the elongated control shaft or handle, but preferably includes a combination of these forms. By so including a combination of manipulation mechanisms, the device provides the surgeon with an added range of motion of the cup, facilitating ease of both placement and application of a tensioning force. The vacuum device may be so utilized with minimal or no trauma to the target tissue or surrounding tissues.
The device may be readily utilized and is particularly desirable in laparoscopic procedures. A trocar is inserted through an incision with a surrounding sheath or cannula. Once the trocar is removed, a compressed cup is advanced through the sheath disposed in the incision. Manipulation of the cup in the abdomen, for example, is facilitated preferably using a combination of the tensioning structures to provide the surgeon with a device that may be utilized in a broad range of procedures.
The invention additionally provides an apparatus by which the tension may be held without the need of a surgical assistant. Once an appropriate traction force is applied to the cup, the tensioning structure, for example, the cord, the hooks, or he vacuum tube are secured in position. The cup may be tethered via the tensioning structure to an external framework such as a frame anchored to or adjacent to the surgical field or directly attached to a self retaining retractor at the incision, or a frame coupled to the table or the like. Alternately, the cup may be tethered to the patient himself via a clamp at the incision site or location.
The device may also be advantageously used to apply a tamponade at a wound site, rupture, laceration, or other bleeding site. By applying a mild vacuum to the site, the target site is squeezed, transmitting a mild pressure which slows or arrests bleeding. This procedure may be utilized both internally, and on external body surfaces as a sort of vacuum tourniquet until the site can be otherwise repaired or treated.